Education and debate

Controversies in Management: Commentary: reliable data are not yet available

Epilepsy is a syndrome of varying aetiology. Although drugs do not seem to be effective in head injured patients, the natural course of epilepsy in these patients seems unlikely to be the same as that in a person with no identifiable cause. The preliminary data on treatment after a first seizure are encouraging but far from definitive, and it is in this area that most effort must be concentrated. The social implications of diagnosing epilepsy after the first seizure are substantial, making it all the more important that reliable data are obtained. Though the widespread use of anticonvulsant drugs prevents a comprehensive study on the natural course of epilepsy in all its forms, the effect of treating or not treating the first seizure should be thoroughly investigated.--PETER C RUBIN, professor of therapeutics, University of Nottingham

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